Provider Demographics
NPI:1083726202
Name:FESTOK, MUHAMAD MAZEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMAD
Middle Name:MAZEN
Last Name:FESTOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 B 2ND AVE SW
Mailing Address - Street 2:B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265
Mailing Address - Country:US
Mailing Address - Phone:256-435-5325
Mailing Address - Fax:256-435-8431
Practice Address - Street 1:1300 PELHAM RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3032
Practice Address - Country:US
Practice Address - Phone:256-435-5325
Practice Address - Fax:256-435-8431
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085813Medicaid
AL000085813Medicaid
AL85813Medicare ID - Type Unspecified